Has Cochrane lost its way?

Melanie Newman asks whether Cochrane has ‘lost its way’ given recent ructions arising from the Governing Board’s decision to remove membership status from Peter Gøtzsche. On the contrary, by all objective measures, Cochrane is thriving.

Feel free to ignore the evidence of sustained income growth that Newman cites. Look instead at the continuing international spread of Cochrane’s networks, increasing its reach in South America, Eastern Europe and South East Asia, and initiating new networks in China and the United States. Look also at the expanding work on multi-language content development, and the doubling in access to review summaries on the Cochrane.org website over the last 12 months, dominated by people from non-anglophone countries. In terms of impact, the use of Cochrane Reviews in guidelines continues apace, most notably at WHO, where in recent years 75% of guidelines produced annually have included Cochrane Reviews. Cochrane is also seeing an expanding number of people getting involved in or supporting its work. In addition to the 12,500 Cochrane members Ms Newman recognises, there are now an additional 43,000 actively registered supporters (compared to 28,000 contributors in 2012).

Underlying this success are the international author teams and 52 Cochrane Review Groups (CRGs), yet they barely rate a mention in Ms Newman’s article, and only one Co-ordinating (lead) Editor is quoted. Likewise, there is no mention of the contribution of the methods community, whose members provide the guidance and methodological peer review that are a crucial part of Cochrane’s international standing.

Cochrane must not be complacent – there are challenges ahead and continued success is not guaranteed. There is undoubtedly concern within the community about the growth of the Central Executive Team (CET) and legitimate questions about the most effective way that Cochrane can invest its resources. It is important that these do not become destructive or divisive. Cochrane is at its most effective when it adheres to its 10 key principles, which promote a culture that is open, diverse, inclusive and outwards facing, a community that is vibrant and iconoclastic, and a mission to search for truth and realism in health care.

It is regrettable that Ms Newman’s article follows a trend that has been evident elsewhere by personalising the blame for Cochrane’s perceived challenges on one person, Cochrane’s CEO, Mark Wilson. This argument neglects Mark’s positive contributions; from the development of the Strategy to 2020, to expanding Cochrane’s international reach, to initiating a membership scheme to open up Cochrane to the world, to providing the infrastructure support for the production of more challenging reviews, and to his commitment to pursuing diverse knowledge translation activities. Rather than credit these positive contributions, the critics focus on the necessary, overdue introduction of 21st century measures relating to good governance and accountability.

Some errors are also unchallenged. Cochrane guidance does not ‘still allow reviewers to review their own studies’. In contrast, Cochrane’s guidance states that trialists should not assess or extract data from their own studies. It is true that Cochrane’s existing strong COI policy is in need of clarification and revision, and this work is in progress.

Whilst all of this goes on, the real Cochrane engine room, the vast and sometimes quiet majority that just wants to produce and disseminate high quality reviews, and to support others engaged in that endeavour, just carries on its work. As Jeremy Grimshaw has noted, despite the recent controversies, between October and December 2018 390 new and updated Cochrane systematic reviews were published, and 1223 Plain Language summaries were translated into 14 languages. In other words, life has continued.